Avoiding Flu Vaccine Shortages for Hospital Staff

Periodic shortages in drug supplies plague all pharmacists
and, if I do say so, pharmacists perform an
admirable job of implementing strategies to cope
with these shortages while optimizing patient outcomes. It
often requires extra work for
many pharmacists and their
staffs, but their efforts are
accomplished collaboratively
with medical staff members
and remain transparent to
patients.

On the other hand, the flu
vaccine shortage of 2004 was a
very public phenomenon. It
was worsened by media hype,
which created fear and limited
availability of the vaccine to
high-risk groups.

Last year, my hospital appointed
an advisory group
composed of pharmacists, infectious
disease physicians,
and representatives from epidemiology,
infection control,
and hospital administration
departments, to develop and implement a program to control
vaccine distribution. The purpose was to prioritize
immunization based on scientific data and guidelines
imposed by federal and state agencies.

In retrospect, I can say that this approach was appropriate,
but it was not efficient or convenient and probably was
not effective. The hospital decided to give patients the highest
priority and severely restricted immunizations to direct
patient caregivers. Whereas decentralized clinical pharmacists
and retail pharmacists were included in the high-priority
group, technicians, central-pharmacy-based staff, and
others without direct patient contact were placed at a much
lower priority level.

By the time the last shipment arrived, the hype had abated,
the incidence of infected patients was only average, and
patients (including health care workers) who had been
denied vaccinations earlier apparently decided to forgo
immunization. At the end of the flu season, the hospital had
thousands of unused doses of
vaccine in its inventory.

This year, the hospital has
taken a different approach
while complying with recommendations
from the Centers
for Disease Control and
Prevention and the Advisory
Committee on Immunization
Practices. All health care workers
will be eligible for vaccine as
a top priority, along with highrisk
patients, on a "first-come,
first-served" basis. We are
encouraging most health care
workers (except those who care
for severely immunocompromised
patients) to consider
using the nasal form of the vaccine.
We are attempting to educate
hospital staff members
about making informed decisions regarding immunization.

I suspect that most hospitals and their pharmacies develop
similar strategies. Yet, do they make sure that the entire
staff understands the strategies and goals? Are they proactive
in working with the media to dispel myths, allay fears,
and encourage optimal utilization? Do they effectively partner
with nearby hospitals and community pharmacy colleagues
to optimize patient outcomes? I wonder.

Mr. McAllister is director of pharmacy at University of NorthCarolina (UNC) Hospitals and Clinics and associate dean forclinical affairs at UNC School of Pharmacy, Chapel Hill.